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Breast cancer in menopausal patients

The risk of developing cancer increases as one age. The age at which one starts menopause affects their cancer risk. Starting menopause after the age of 55 increases the risk of developing breast cancer due to exposure to a higher level of estrogen (Wang et al, 2020). The risk of breast cancer is increased by late menopause. Menopause in women that have breast cancer affects the quality of life negatively. Breast cancer causes skin and hair changes. It makes hair fall out all over the body. Breast cancer causes joint pains and bone thinning. The breasts might change in size and color. They might be swollen due to the tumors.

Breast cancer in menopausal patients

Global relevance

There were more than 130,00 and 490,000 deaths in the premenopausal and postmenopausal breast cancer groups worldwide in 2018. Breast cancer in menopausal patients is relevant because the number of individuals that have been succumbing to the disease has increased. The disease has been reported in various parts of the world. The survival rates of breast cancer in menopausal patients vary from one country to another. For those in high-income countries, the survival rates are high while for those in low-income countries, the survival rates are low. The incidence of cancer in developing nations has increased steadily (Shin et al,2019).

There is a disparity in the availability of detection programs in various countries. Breast cancer in menopausal patients is likely to be treated for patients that come from developing nations. Countries that have been undergoing economic and social transitions have had more cases of postmenopausal breast cancer. Many breast cancer deaths could be avoided worldwide by improving the health outcomes for menopausal patients.

National relevance

Breast cancer in menopausal patients is relevant in the US because it affects a lot of people. The most commonly diagnosed cancer Among American women is breast cancer. 12 percent of women that are born in the US develop breast cancer. The risk of getting diagnosed with cancer increases with age. Those in menopause are more likely to get diagnosed. There have been many deaths due to breast cancer in the US. For women aged 50 years and above, death rates from cancer have been decreasing (Sun et al, 2018).

The decrease in death rates has been due to early detection and treatment advances. Breast cancer is more common in blacks than whites in the US. There is national relevance of breast cancer because there have been many people suffering from the disease, and continued research has been done to identify more effective treatments. The US has spent a lot of money on the treatment of menopausal patients with breast cancer (Sun et al, 2018).

The risk factors for breast cancer are significantly increased by a western lifestyle. Exposure to estrogen has been one of the major risk factors for breast cancer among US citizens. Some breast cancers among menopausal patients in the US have been linked to gene mutations. Mutations are inherited from one father or mother (Nabieva et al, 2019). Women that have BRCA1 gene mutations are very likely to develop breast cancer. The US has a significant number of aging population. Therefore, diseases such as breast cancer are relevant due to the increased risk of getting the disease as one age.

Local relevance and perspective

Breast cancer among menopausal patients is relevant locally because more people are getting diagnosed. Many local people believe that cancer is a "white disease". There is conflicting information from health providers, media, and family members to the menopausal patients with breast cancer (Yeo et al, 2020). Women in various localities have limited knowledge of the subtypes of cancer. Some people are not concerned about the disease because they do not have a family history of the disease. Those who consume less healthy diets are at a higher risk of getting breast cancer in menopause.

Promotion strategies

Breast cancer in menopausal patients is a global health problem. The disease tends to affect people from many countries. There is a need to develop awareness among individuals. They should obtain factual information about breast cancer. Those in menopause might be at a higher risk of developing breast cancer (Trichopoulos et al, 2021). It is good to encourage them to adopt healthy lifestyles. At the global level, the problem should be addressed by organizations such as the World Health Organization. The government should take appropriate measures to address the problem at national and local levels.

Health Problem

Breast cancer is a major health concern among women. It is a major cause of mortality among women in the United States and the most common type of cancer in women accounting for 30% of cancer reported among women (Ellington et al., 2022). The risk of developing breast cancer among U.S women is 12.4%, that is, one in every eight women (Momenimovahed & Salehiniya, 2019). The risk of breast cancer increases with an increase in age, particularly among women aged 50 years old or above (Momenimovahed & Salehiniya, 2019). The U.S. Preventive Services Task Force recommends women aged between 50-74 years undertake breast cancer screening, while those aged between 20 to 49 years should discuss their cancer risk with their providers (Ellington et al., 2022).

The proposed health promotion program would be targeted at menopausal women to improve their knowledge on the risk of developing breast cancer. The program would utilize pedagogical groups, which will allow women to work together to enhance their breast cancer awareness. Each member of the group will be required to participate in enhancing their understanding and facilitating collective and collaborative learning. The individuals involved in the health promotion program will be educated about the preventive methods that can be used to protect them from getting breast cancer. The program will be essential in helping menopausal patients to live healthier lives.

Vulnerable Population

Menopausal women can easily develop breast cancer than other age groups. As such, the cases of breast cancer are higher after menopause than before menopause, which indicates that the risk increases with age (Heer et al., 2020). One of the major risk factors that expose menopausal women to breast cancer is age. In 2018, Heer et al. (2020) indicated the new breast cancer cases among postmenopausal women was 1.4 million, while about 645,000 cases were reported among premenopausal women globally.

The other risk factor is obesity, as obese older women are at a higher risk than those with normal weight. Mohanty and Mohanty (2019) suggested that postmenopausal obesity increases breast cancer risk since adipose tissue is a major reservoir for the biosynthesis of estrogen after menopause. Besides, physical activity at menopause also influences the breast cancer risk at menopause. Niehoff et al. (2019) established that women with a low activity level at menopause are more likely to be affected than those that are physically active.

Review of literature

Evidence-based interventions can be used to educate menopausal women and reduce the risk of developing breast cancer. Sauter (2018) recommended the Gail breast cancer risk assessment tool (BCRAT) as an effective tool for estimating the risk of getting breast cancer. The assessment tool can be useful as a breast cancer prevention strategy as women that are found to be at a higher risk of breast cancer can modify their lifestyles to avoid modifiable risk factors. Also, the knowledge of breast cancer risk can help menopausal women to get an early diagnosis, which is a major factor that determines the effectiveness of treatment.

Anastasi and Lusher (2019) stated that breast screening awareness influences the behaviors of women, increasing their likelihood to conduct breast self-examination and attend breast cancer screening when they identify any abnormalities on their breasts. There is a close association between breast cancer awareness and the uptake of screening services among women (Anastasi & Lusher, 2019). In another study, Pan et al. (2019) found that weight loss intervention can be used to reduce the cases of breast cancer in postmenopausal women. Weight loss is a lifestyle intervention that can be used to encourage women to modify their dietary intake to mitigate breast cancer risk.

Strength and weakness

Sauter (2018) reviewed current literature on the approaches that can be used in preventing breast cancer. The major strength of the article is that it provides evidence on various interventions that can be used in the primary prevention of breast cancer. The author used current evidence to support their ideas, which makes the source appropriate for use in evidence-based practice. The main weakness of the article is that it is not a primary source. Primary sources provide firsthand evidence collected from research.

Anastasi and Lusher (2019) explored the effectiveness of breast screening awareness on patients’ attendance in breast cancer screening. The major strength of the article is that it provides information about the effectiveness of an intervention that can be used as an intervention to prevent breast cancer. The article provides a systematic review of high-quality evidence from scholarly articles derived from leading British nursing databases. The main weakness of the article is that it does not provide adequate summaries of the articles reviewed. In the other study, Pan et al. (2019) examined the findings of two complementary studies that investigated the relationship between weight loss and dietary patterns on breast cancer outcomes in postmenopausal women. The strength of the source is that the studies reviewed were primary studies with relatively large samples, which enhances the reliability of the findings. The weakness of the source is inconsistent information, as the two studies reviewed had different hypotheses.

Framework for the proposal

The Stages of Change model is the most preferred framework for the proposed health promotion program as it describes how individuals integrate new behaviors (Liu et al., 2018). The model provides five stages through which individuals modify their behaviors. The first stage is pre-contemplation, in which individuals have no intention to alter their behaviors since they are unaware of their problems or are not committed to acting. In this stage, the target individuals will be provided with the information to influence them to develop the urge to modify their behaviors. The second stage is the contemplation stage, where individuals intend to act in the near future, probably the next six months, as they recognize the need for change. In this stage, the target menopausal women targeted by the proposed health promotion would be informed about the pros and cons of changing their behaviors.

In the third stage, the preparation stage, individuals are willing to act within the next thirty days. They begin to take the necessary steps towards the target behavioral change and believe that the change would have a positive health outcome. The fourth stage is action, where individuals modify their behaviors and are willing to take more steps forward with the behavior change. In this stage, the individuals would modify their existing behaviors or adopt new healthier behaviors and commit their time and energy towards the change. The last stage is maintenance, where people focus on ways to sustain the change and also prevent relapse. In this stage, menopausal women would be keen to utilize the knowledge they have gained from the health promotion program. The Stages of Change model allows the program organizers to understand that change does not occur instantly and individuals require time to change their behaviors (Liu et al., 2018).

MAP-IT stands

Breast cancer in menopausal patients is a high-risk factor in women. With this in mind, we are partnering with the Florida Health Department, Health People 2020 and CDC to ensure that our women are protected from health risks. In this partnership, we aim to ensure that women at a high risk of breast cancer are educated on detecting early signs of breast cancer. We aim to achieve this goal by heavily investing in patient education (Biglia, 2020).

With the partnerships onboard, the assessment will be done by a team of doctors to determine if the program is being excutd in an anticipated manner. After each week, a report will be sent to the partners (Biglia, 2020). The report will indicate the areas covered, how many patients returned positive cases of breast cancer and the stage of breast cancer on each patient who returned positive results.

The program will be planned effectively to ensure that the objectives will be effectively met. The first planning stage will set up teams that will move in their designated areas (Ohlschlegel, 2018). The teams will be required to do testing and provide patient education on the targeted patients. Each team will be required to provide a report used to write the final report to be sent to the partners.

A team from all the partners will do the implementation. The partners onboard will be required to provide two personnel who will represent them in the program (Ohlschlegel, 2018). The individuals from the different partners will be tasked with implementing the program and ensuring they meet the intended goals. The main responsibilities of the implementation team will be to provide resources and monitor the utilization of the resources within the duration of the program .

Tracking will assess how effective the plan is by impacting patient education (Lagord et.al, 2019). The program's main goal is to ensure that the targeted audience can identify the early signs of breast cancer and seek treatment. Frequent evaluation of the goal will ensure that the program achieves the intended goals and objectives.

SMART goal (of this project)

Menopausal patients will improve awareness about the risk for developing breast cancer during the three months after diagnosis through pedagogical (focus) groups

References

Anastasi, N., & Lusher, J. (2019). The impact of breast cancer awareness interventions on breast screening uptake among women in the United Kingdom: A systematic review. Journal of Health Psychology, 24(1), 113-124. https://doi.org/10.1177/1359105317697812

Biglia, N. (2020). Breast Cancer Service Accreditation Project. European Journal of Cancer, 50, 34–43. https://doi.org/10.1016/s0959-8049(14)70085-1

Ellington, T. D., Miller, J. W., Henley, S. J., Wilson, R. J., Wu, M., & Richardson, L. C. (2022). Trends in breast cancer incidence, by race, ethnicity, and age among women aged≥ 20 years—United States, 1999–2018. Morbidity and Mortality Weekly Report, 71(2), 43. http://dx.doi.org/10.15585/mmwr.mm7102a2

Heer, E., Harper, A., Escandor, N., Sung, H., McCormack, V., & Fidler-Benaoudia, M. M. (2020). Global burden and trends in premenopausal and postmenopausal breast cancer: a population-based study. The Lancet Global Health, 8(8), e1027-e1037. https://doi.org/10.1016/S2214-109X(20)30215-1

Lagord, C., Kearins, O., Lawrence, G., Bishop, H., Monypenny, I., & Bates, T. (2019). Breast cancer clinical outcome measures project: National results from Year 1. Breast Cancer Research, 8(S1), 22–28. https://doi.org/10.1186/bcr1483

Liu, K. T., Kueh, Y. C., Arifin, W. N., Kim, Y., & Kuan, G. (2018). Application of transtheoretical model on behavioral changes, and amount of physical activity among university’s students. Frontiers in Psychology, 2402. https://doi.org/10.3389/fpsyg.2018.02402

Mohanty, S. S., & Mohanty, P. K. (2019). Obesity as potential breast cancer risk factor for postmenopausal women. Genes & Diseases, 8(2), 117–123. https://doi.org/10.1016/j.gendis.2019.09.006

Momenimovahed, Z., & Salehiniya, H. (2019). Epidemiological characteristics of and risk factors for breast cancer in the world. Breast Cancer (Dove Medical Press), 11, 151–164. https://doi.org/10.2147/BCTT.S176070

Nabieva, N., Fehm, T., Haeberle, L., de Waal, J., Rezai, M., Baier, B., … & Fasching, P. A. (2018). Influence of side-effects on early therapy persistence with letrozole in postmenopausal patients with early breast cancer: Results of the prospective EvAluate-TM study. European journal of cancer, 96, 82-90.

Niehoff, N. M., Nichols, H. B., Zhao, S., White, A. J., & Sandler, D. P. (2019). Adult physical activity and breast cancer risk in women with a family history of breast cancer. Cancer Epidemiology, Biomarkers & Prevention, 28(1), 51–58. https://doi.org/10.1158/1055-9965.EPI-18-0674

Ohlschlegel, J. (2018). Effectiveness of planned teaching program (PTP) on breast cancer among working women at selected colleges in Haridwar, Uttrakhand. International Journal of Science and Research (IJSR), 5(5), 1036–1040. https://doi.org/10.21275/v5i5.nov163493

Pan, K., Luo, J., Aragaki, A. K., & Chlebowski, R. T. (2019). Weight loss, diet composition and breast cancer incidence and outcome in postmenopausal women. Oncotarget, 10(33), 3088–3092. https://doi.org/10.18632/oncotarget.26864

Sauter, E. R. (2018). Breast cancer prevention: Current approaches and future directions. European Journal of Breast Health, 14(2), 64–71. https://doi.org/10.5152/ejbh.2018.3978

Shin, J. J., Choi, Y. M., Jun, J. K., Lee, K. H., Kim, T. Y., Han, W., & Im, S. A. (2019). Amenorrhea and menopause in patients with breast cancer after chemotherapy. Journal of breast cancer, 22(4), 624-634.

Sun, L., Zhu, Y., Qian, Q., & Tang, L. (2018). Body mass index and prognosis of breast cancer: An analysis by menstruation status when breast cancer diagnosis. Medicine, 97(26).

Trichopoulos, D., MacMahon, B., & Cole, P. (2021). Menopause and breast cancer risk. Journal of the National Cancer Institute, 48(3), 605-613.

Wang, C., Chen, C., Lin, Y., Zhou, Y., Mao, F., Zhu, H., … & Sun, Q. (2020). Validation of CTS5 model in large-scale breast cancer population and the impact of menopausal and HER2 status on its prognostic value. Scientific reports, 10(1), 1-9.

Yeo, W., Pang, E., Liem, G. S., Suen, J. J., Ng, R. Y., Yip, C. C., … & Mo, F. K. (2020). Menopausal symptoms in relationship to breast cancer-specific quality of life after adjuvant cytotoxic treatment in young breast cancer survivors. Health and quality of life outcomes, 18(1), 1-9.

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Sexually Transmitted Diseases in Women Adolescents

Sexual Transmitted Diseases (STDs) are ravaging the lives of many young people, especially women in universities and other institutions of higher learning. At the global level, the prevalence of STDs among women has been on the rise with the number of people exposed to alcohol and drug abuse. More than one million STIs are contracted every day on a global scale. STDs in adolescent women have a significant impact on reproductive health because they claim lives and lead to poor health outcomes (Bütschi, Cattacin, & Panchaud, 2018). The STDs are substantial in the fight for healthier wellbeing because as more people are infected, their quality of life is lowered.

Sexually Transmitted Diseases in Women Adolescents

Global Relevance

STDs among women are significant in the world because they have threatening complications. When adolescent women are affected with STIs, the aftermaths of the diseases may lead to cancer, abortions, neurologic damage, and death. Some cancers involve people so that they will be unable to conceive and get pregnant in the long run. The quality of life among adolescent women depends on their sexual status. When they are affected by STDs, they will be prone to contact other opportunistic diseases, and the global outcome for health and wellbeing will be impacted (Cowan & Mindel, 2020).

National Relevance

The national relevance of STDs is the lowering of tax levels and the negative outcome in people's lives. When more people are affected by STDs, they will not be productive in their places of work, and consequently, they will no longer produce taxes to the government. In the long run, the GDP per capita of the country will be affected, and the level of dependents will increase. A nation where people are concerned with STDs will experience a population decline because some of the complications associated with the STDs is the inability of a person to give birth (Moore, Rosenthal & Mitchell, 2020).

When a person is affected with an STD, it will lead to lower quality of life because of its stigma. Discrimination among people is likely to affect adolescents, and they will not interact well in society. Consequently, they will spend most of their time alone and commit suicide in the discourse. Deaths rate are likely to increase in a country, and awareness should be conducted both to the infected and the other people affected in the society (Moore et al., 2020). The government must be prepared to install institutions to take care of people affected by STDs at the national level.

Local Relevance

The prevalence of STDs can only be reduced if its transmission rate is interrupted. The STD perspective at the local level is that people have the ability to prevent the disease if they want to do so courtesy of knowledge about the disease. Therefore, it is prudent for the local authorities to create awareness and educate people on STDs, how to reduce them, and take care of the people infected. When people are aware of the preventive measures for the given disease, they will deduce the best ways of avoiding the disease. For example, STD awareness may focus on the three main factors presented as acronym ABC, meaning abstain, be faithful, and use condoms. Such lessons will ensure that people remain safe (Reeves & Quiroz, 2018).

Health Promotion

Healthcare promotion is the most efficient strategy to overcome the global pandemic such as STDs. When people are aware of the preventive measures of a disease, they will take all precautions, such as abstaining and seeking medical care to ensure they are well taken care of. The global effort can be made from the World Health Organization to nations, giving better outcomes. When there was covid-19, the awareness programs started from the WHO to governments, and each government-organized grassroots campaigns to ensure that people were safe from the virus (Sodik, 2018). The efforts to curb STDs like HIV/AIDS differ in different caders and scales. The global scale is concerned with research, innovations, and better ways to manage the disease. At the national level, governments work around the clock to ensure that people are tested, and those found infected are registered for medication. On the other hand, local levels deal with awareness to ensure many people know the risk factors and the respective strategies to overcome them.

Health Problem

Sexually transmitted diseases (STDs) are acquired through sexual contact with a person infected with the disease, which may involve oral, anal, or vaginal sex. They can be transmitted through parasites, viruses, or bacteria. STDs have a significant effect on the reproductive and sexual health of individuals across the world. In 2018, about one in five adults had an STD in the United States (Tuddenham et al., 2022). The common types of STDs are genital herpes, trichomoniasis, genitalium, HIV, syphilis, mycoplasma, chlamydia, and gonorrhea. STDs are more common among ethnic minorities in the U.S. and are a significant cause of fertility problems in women (Tuddenham et al., 2022).

The health promotion program will focus on advocating for adolescent women, particularly those who are sexually active, to be take screening tests for STDs in the first month after they have had their initial consultation. The program will allow the women to be educated about their sexual health and provided with brochures that would enhance their knowledge about STDs. The individuals involved in the program will be able to identify STDs and the need to perform annual screening. They will be provided with digital education and brochures to promote their understanding of STDs and encourage them to adopt healthier behaviors.

Risk Factors

Adolescent girls are among the most vulnerable groups to getting STDs in the U.S. Adolescent women aged between 15- and 24-years old account for sixty-eight percent of the cases of chlamydia in U.S. women (Scott-Sheldon & Chan, 2020). One of the factors that expose young women to the risk of contracting STDs is early sexual debut. Howard et al. (2021) established that early sexual debut and forced sexual initiation significantly increased the risk of STDs, as they are more likely to develop risk behaviors that expose them to STDs.

Substance abuse is a major risk factor that makes adolescent women vulnerable to STDs. Gamarel et al. (2018) established that there is a close association between substance use and the risk of developing STDs among young people. Substance use may impair the behaviors of young people exposing them to sexual risk behaviors. Besides, the lack of use of preventive methods increases the risk of STDs in adolescent women. Kroeger et al. (2018) established that young women lack knowledge on the methods that can be used to prevent STDs, which exposes them to infections and also prevents early diagnosis.

Health Promotion

Various evidence-based interventions can be used to promote STD screening among adolescent women. Ippoliti and L’Engle (2017) established that mobile health programs for educating adolescents about sexual health could improve their understanding of sexual health and promote their health-seeking behaviors. The increased use of mobile phones among young people creates an opportunity that can be utilized to address the public health concern by promoting STD knowledge and available STD screening services. The intervention can be effective in promoting STD prevention and filling the knowledge gap about STDs among young women.

Self-sampling methods (SSMs) can be used to promote STD screening and improve the health of young women. SSMs are methods used to obtain self-samples to detect STDs. Griner et al. (2019) suggested that SSMs are accepted by young women and can influence their uptake of STD screening as they allow them to avoid interacting with providers. In another study, Lameiras-Fernández et al. (2021) stated that school-based sex education could be effective in promoting sexual health knowledge and helping individuals to make informed decisions about their reproductive health, and improving STD testing. The study indicated found that digital sex education, such as the use of text messaging, increased sexual health awareness, reduced unprotected sex, and increased STDs testing among young people (Lameiras-Fernández et al., 2021).

Evidenced-based Scholarly Sources

The evidenced-based scholarly sources have both strengths and weaknesses. The major strength of Ippoliti and L’Engle (2017) is that the researchers provided evidence from different projects conducted in different parts of the world, which increases the applicability of the findings. The studies reviewed were conducted in Africa, Latin America, and Eurasia, among other countries. The weakness of the source is that most of the projects were conducted in low- and middle-income countries, which makes them less applicable in developed countries. The strength of Griner et al. (2019) was that the article is a primary source that provides first-hand information on the effectiveness of SSMs in STD screening. The main weakness of the source is that the study was theoretical and did not provide practical experimentation of the effectiveness of SSMs in promoting STD screening.

The major strength of Lameiras-Fernández et al. (2021) was that the study reviewed scientific evidence from peer-reviewed sources, which provide credible evidence that can be used in evidence-based practice. The papers reviewed were collected from international nursing databases and focused on the studies with the lowest risk of bias, and 16 out of the 20 reviews included U.S. samples. However, most of the studies reviewed had small sample sizes, which increases the margin of error and reduces the power of the studies to make reliable conclusions.

Health Promotion Model

The health belief model (HBM) is the best framework for the health promotion program as it allows individuals to predict individuals' health behaviors. The model can be used as a guide for health promotion and in the implementation of programs designed to prevent diseases. The HBM is popular in health education and can be used to provide a theoretical framework for health promotion programs. The model explains changes in the behaviors of individuals and can help in achieving optimal behavioral change. Health beliefs influence individuals’ willingness to change their behaviors. As such, individuals’ unhealthy behaviors can be modified by influencing their beliefs. Chen et al. (2019) established that there is a close relationship between individuals’ health beliefs and a healthy lifestyle. To promote a healthy lifestyle, it is important to find ways of influencing individuals’ health beliefs.

The model would be used in the program to influence the health behaviors of adolescent women and encourage them to take STD screening tests. Azadi et al. (2021) established that the HBM could be used in health education to promote individuals’ preventive behaviors. STD screening is a preventive intervention that is used in the prevention of STDs. Therefore, the HBM would be appropriate to promote the preventive behaviors of adolescent women who are at a high risk of contracting STDs due to lack of knowledge of the appropriate sexual health behaviors, as well as the importance of STD screening in the prevention of STDs.

MAP-IT stands

The initiative for the improvement of sexual health among women adolescents should be established on integrating the efforts of multiple parties and utilization of different strategies at the same time. The initiative entails bringing together educational institutions, healthcare facilities, and politicians. The purpose of the group is to implement protocols that will ensure that sexually transmitted infections are no longer a problem among adolescents. The primary role is to bring together people who can contribute to the resources for the initiative (McCann et al., 2021).

The problem is that despite the progress in tackling STIs, adolescents still face significant infection levels. It is important that these levels be minimized to negligible or below average rates compared to the general population. This is achievable as there are effective strategies that have been influential in improving sexual health. The data collection should mainly take place in educational institutions as they carry the target age group in the population. The data will entail being sexually active, use of protection, and medical check-ups (Keller, 2020).

Medical personnel will provide data on the treatment of adolescents. The initiative will primarily rely on proven int

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